| NPI | 1700506532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC EXILUS Owner 302-722-4740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2024-03-05 |